Abstract

Contemporaneous primary cutaneous lymphomas have been observed, particularly involving mycosis fungoides with other T-cell disorders such as lymphomatoid papulosis and anaplastic large cell lymphoma. Association of mycosis fungoides with primary B-cell lymphoma, however, is much less commonly reported. We present a 64-year-old male, with no significant past medical history, who was evaluated by dermatology for with a rash on his right upper extremity consisting of grouped, erythematous papules. A punch biopsy demonstrated a dense dermal infiltrate of small T- and B-cell lymphocytes, including monocytoid lymphocytes, as well as dense aggregates of kappa-restricted plasma cells. Subsequent PET and bone marrow biopsy showed no evidence of disease and a diagnosis of primary cutaneous marginal zone lymphoma was made. The patient was treated with involved site radiation therapy (ISRT) which led to complete resolution of the right upper extremity rash. Approximately 11 months after completion of therapy, the patient presented to dermatology for follow-up, with concern for a firm, red-purple papule on his proximal right lower extremity. A punch biopsy demonstrated prominent epidermotropism of enlarged lymphocytes with hyperchromatic and irregularly contoured nuclei. The atypical lymphocytes showed expression of CD3 and CD4 but no appreciable staining for CD8 or CD7. A diagnosis of cutaneous T-cell lymphoma (mycosis fungoides) was made. This case is an unusual example of a patient being diagnosed, within a short period of time, with two distinct cutaneous lymphoproliferative diseases of B- and T-cell lineages.

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